Bilateral staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of essential tremor: a case series study
Bilateral staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of essential tremor: a case series study
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DOI：
10.1136/jnnp-2020-325278
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发表时间：
2021-09-01
影响因子：
11
通讯作者：
Obeso, Jose A.
中科院分区：
文献类型：
--
作者：
Martinez-Fernandez, Raul;Mahendran, Sujitha;Obeso, Jose A.
单侧磁共振引导聚焦超声（FUS）丘脑切开术是治疗难治性特发性震颤（ET）的有效方法。双侧FUS消融的可行性尚未探索。方法对诊断为难治性ET并在至少5个月前接受过单侧FUS丘脑切开术的患者进行双侧治疗。时间点为基线（首次丘脑切开术前）和FUS 1和FUS 2（分别为第二次丘脑切开术前4周和术后6个月）。主要终点是安全性。通过震颤临床评定量表（CRST）评估疗效，CRST包括震颤检查（A部分）、任务表现（B部分）和震颤相关残疾（C部分）子量表。结果9例患者全部治愈。未记录永久性不良事件。6名患者出现轻度步态不稳和1名构音障碍，均在最初几周内消退。3例患者报告口周感觉减退，1例消退。CRST总评分从基线到FUS 2改善了71%（从52.3 +/- 12到15.5 +/- 9.4，p
Background Unilateral magnetic resonance-guided focused ultrasound (FUS) thalamotomy is efficacious for the treatment of medically refractory essential tremor (ET). Viability of bilateral FUS ablation is unexplored. Methods Patients diagnosed with medically refractory ET and previously treated with unilateral FUS thalamotomy at least 5 months before underwent bilateral treatment. The timepoints were baseline (before first thalamotomy) and FUS1 and FUS2 (4 weeks before and 6 months after second thalamotomy, respectively). The primary endpoint was safety. Efficacy was assessed through the Clinical Rating Scale for Tremor (CRST), which includes subscales for tremor examination (part A), task performance (part B) and tremor-related disability (part C). Results Nine patients were treated. No permanent adverse events were registered. Six patients presented mild gait instability and one dysarthria, all resolving within the first few weeks. Three patients reported perioral hypoesthesia, resolving in one case. Total CRST score improved by 71% from baseline to FUS2 (from 52.3 +/- 12 to 15.5 +/- 9.4, p